Provider Demographics
NPI:1649914607
Name:STAAB, JEROME JOSEPH
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:JOSEPH
Last Name:STAAB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11875 S SUNSET DR STE 300
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-2794
Mailing Address - Country:US
Mailing Address - Phone:712-577-1669
Mailing Address - Fax:
Practice Address - Street 1:8788 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-2041
Practice Address - Country:US
Practice Address - Phone:913-826-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker